الفهرس 
Pattern of prostate cancer among Egyptian men undergoing initial transrectal ultrasound – guided biopsy with PSA level between 2.5 – 10 ng/ml
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Abstract
Introduction: prostate cancer (PCa) is a major health problem in men that was not sufficiently studied in Egypt. The incidence of PCa in Egyptian men is much lower than that in the western countries. Serum PSA, as a PCa marker used to trigger transrectal guided prostate biopsy (TRUSBP), showed racial and ethnical variations. Subsequently, a large proportion of Egyptian men undergo unnecessary prostate biopsies with its complications.
Objective:we aimed to evaluate PCa detection rates among Egyptian men who underwent TRUSPB for prostate-specific antigen (PSA)levels between 2.5 to 10 ng/ml and to evaluate the PSA cut-off value for TRUSPB among Egyptian men.
Material and Methods:This Prospective diagnostic interventional study was carried out between August 2018 and July 2021.All 400 Egyptian men between 50-70 years old who had PSA levels between 2.5-10 ng/ml underwent 12-cores TRUSBP in our clinic. Mean PSA level, % free PSA (% fPSA), PSA density (PSAD), prostate volume and PCa detection rates were evaluated. Quantitative data were expressed as mean± standard deviation (SD). Receiver-operating characteristic (ROC) curve used for prediction of prostate cancer using the total PSA.
Results:Histopathological examination of the biopsies revealed adenocarcinoma of the prostate in 14.2% (57/400), PIN/ASAP in 3.8% (n=15/400), and BPH in 82% (n=328/400). For patients with PCa, a Gleason Score of 6, 7(3+4), 7(4+3), 8, 9, and 10 was found in 4%, 3%, 1.8%, 1.3%, 2.8, and 1.5%, respectively.
The patients (n=400) were categorized into two main categories according to their serum tPSA levels: 2.5-4ng/ml (n=31), ˃4-10ng/ml (n=369). Their corresponding overall PCa biopsy detection rates, regardless of DRE findings, were 6.45% (2/31) and 14.9% (55/369), respectively. This difference was statistically significant. In our study 57 patients were diagnosed with prostate cancer, 2 of which (3.5%) had PSA 2.5-4 while the remaining 96.5% (n=55) had a PSA 4-10. This difference was statistically significant (p> 0.046). ROC analysis identified a tPSA cutoff value of 8.36 to correctly identify PCa with an accuracy of 74.2%. This cutoff had a higher sensitivity (80.4%) & lower specificity (67.4%).
Conclusion: Total serum PSA varies amongst different ethnicities and races. Egypt -as an Arab country- has a relatively lower prevalence of prostate cancer compared to other Western countries. Accordingly, a cut-off value of tPSA needed to trigger a TRUSPB amongst Egyptian men with serum PSA levels between 2.5 and 10ng/ml could be higher and different to that needed to trigger a prostate biopsy amongst other populations.